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Chylothorax After Single-Chamber Implantable Cardioverter-Defibrillator Extraction

Marco Radaelli1, Mohammad Saad Husain1, Julian Armijo-Alba1

  • 1Internal Medicine Teaching Service, MedStar Washington Hospital Center/Georgetown, Washington, DC, USA.

JACC. Case Reports
|June 6, 2025
PubMed

Insights

Cardiac implantable electrical device (CIED) lead extraction can rarely cause chylothorax, a serious complication. Early recognition and management are vital for patient outcomes.

Area of Science:

  • Cardiology
  • Thoracic Surgery
  • Critical Care Medicine

Background:

  • Cardiac implantable electrical device (CIED) lead extraction is a common procedure, with approximately 15,000 cases annually.
  • While generally safe, CIED lead extraction carries risks of potential complications that necessitate awareness for optimal patient management.

Observation:

  • A 63-year-old male with multiple comorbidities underwent implantable cardioverter-defibrillator lead extraction due to device pocket infection.
  • Following the procedure, the patient experienced progressive hypoxic respiratory failure and a new right-sided pleural effusion, diagnosed as chylothorax.

Findings:

  • This case represents the first reported instance of chylothorax occurring after CIED lead extraction.
  • Despite initial conservative management, the patient's condition worsened, culminating in cardiac arrest and death.

Implications:

  • Chylothorax should be considered in the differential diagnosis for patients presenting with new pleural effusions post-CIED lead extraction.
  • Prompt recognition and timely, appropriate management of rare complications are critical, particularly in high-risk patient populations undergoing CIED lead extraction.
Abstract

Keywords:
cardiac pacemakerchronic heart failurechylothoraxpleural effusionreduced ejection fractionsystolic heart failure

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